Rise in Opioid-Related Deaths Associated with COVID-19 Pandemic

Tara Gomes, PhD

The COVID-19 pandemic introduced challenges to opioid care, with data from North America suggesting the rate of opioid-related deaths increased due to the pandemic.

Investigators, led by Tara Gomes, PhD, Keenan Research Centre of the Li Ka Shing Knowledge Institute, St. Michael’s Hospital, found an additional 17,843 years of life in Ontario, Canada were lost due to opioid overdose during the first 6 months of the COVID-19 pandemic, compared to the 6 months prior.

Investigators defined an opioid-related death as an acute intoxication or toxicity death resulting from the direct contribution of an opioid.

Study

Gomes and colleagues used a cross-sectional time series analysis of weekly fatal opioid overdoses among people aged 15 years or older in Ontario from January 2018 – September 2020.

The investigators compared fatal overdose rates and characteristics between 3-month periods.

The COVID-19 period was determined from March – September 2020, beginning with the state of emergency in Ontario.

Period 1 included the same 6-month period in the previous year, March – September 2019. Period 2 included the 6-month period before the COVID-19 period, September 2019 - March 2020.

The team collected data on all confirmed or suspected opioid-related deaths in Ontario, including age, sex, rural or urban residence. They also determined if fentanyl, stimulants, or benzodiazepines were detected and if naloxone was administered.

Characteristic across the 3 periods were compared using χ2 and t tests. The team used methods from the Global Burden of Disease study to calculate years of potential life lost (YLL) due to fatal opioid overdose.

Results

Investigators found the weekly number of opioid-related deaths increased 135%, from 23 to 54 deaths.

The most growth occurred among patients younger than 35 years, with a 320% increase from 5 – 21 opioid-related deaths weekly.

A total of 2774 individuals died from an opioid-related cause, with 2037 (73.4%) men and 1311 (47.2%) aged 35 – 54 years during the 6-month periods of interest.

The team noted that in the first 6 months of the pandemic, 1237 people died of opioid-related causes (99.3 per million, 49,155 YLL).

In period 1 2, 766 people (62.4 per million, P <.001), leading to 30,286 YLL. In period 2, 771 people (61.9 per million, P <.001) died of opioid-related causes, leading to 31.312 YLL.

The characteristics of fatal overdose were similar between periods, but there were significant increases between period 2 and COVID-19.

The proportion of deaths among men increased from 528 (68.5%) to 948 (76.7%), P <.001.

The prevalence of fentanyl increased from 586 (70.6%) to 1056 (85.4%), while the prevalence of stimulants increased from 485 (62.9%) to 880 (77.1%), all P <.001.

Conclusion

Investigators concluded the rising rates of opioid-related deaths among young adults placed a increasing burden on society.

“The rising rates of harm among young adults as well as the increased contributions of fentanyl and stimulants to these deaths emphasize the urgent need for low-barrier access to evidence-based harm reduction services and treatment for opioid use disorder in all jurisdictions grappling with the overdose–COVID-19 syndemic,” investigators wrote.

The study, “Measuring the Burden of Opioid-Related Mortality in Ontario, Canada, During the COVID-19 Pandemic,” was published online in JAMA Network Open.